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A.

Definisi
In cholelithiasis, calculi (gallstones) usually form in the gallbladder from solid
constituents of bile and vary greatly in size, shape, and composition. There are two major
types of gallstones: pigment stones, which contain an excess of unconjugated pigments in the
bile, and cholesterol stones (the more common form), which result from bile supersaturated
with cholesterol due to increased synthesis of cholesterol and decreased synthesis of bile
acids that dissolve cholesterol.
B. Faktor Resiko
Risk factors for pigment stones include cirrhosis, hemolysis, and infections of the biliary
tract. These stones cannot be dissolved and must be removed surgically. Risk factors for
cholesterol stones include gender (women are two to three times more likely to develop
cholesterol stones); use of oral contraceptives, estrogens, and clofibrate; age (usually older
than 40 years); multiparous status; and obesity. There is also an increased risk related to
diabetes, GI tract disease, T-tube fistula, and ileal resection or bypass.
C. Gejala dan Tanda
1. May be silent, producing no pain and only mild GI symptoms
2. May be acute or chronic with epigastric distress (fullness, abdominal distention, and
vague upper right quadrant pain); may follow a meal rich in fried or fatty foods
3. If the cystic duct is obstructed, the gallbladder becomes distended, inflamed, and
eventually infected; fever and palpable abdominal mass; biliary colic with
excruciating upper right abdominal pain, radiating to back or right shoulder with
nausea and vomiting several hours after a heavy meal; restlessness and constant or
colicky pain
4. Jaundice, accompanied by marked itching, with obstruction of the common bile duct,
in a small percentage of patients
5. Very dark urine; grayish or clay-colored stool
6. Deficiencies of vitamins A, D, E, and K (fat-soluble vitamins)

Cholesterol gallstones usually contain >50% cholesterol monohydrate plus an admixture of calcium salts. bile pigments. Serum alkaline phosphatase. fattyacids. They are associated with hyperbilirubinbilia (biliary hypersecretion of bilirubin conjugates) and hemolytic diseases. with pigment stones comprising less than 20%. E. Cholesterol stones and biliary sludge It is not known why the hepatocytes secrete bile that is supersaturated with cholesterol. Proposed mechanisms include: (1) an enzymatic defect that increases the hepatocytes’ synthesis of cholesterol. (5) genetic predisposition. (3) decreased resorption of bile salts from the ileum. Laparoscopy 3. Cholecystogram. Ultrasonography. EUS 4. Black pigmented stones are formed in a sterile environment and consist primarily of calcium bilirubinate polymer. Pigment stones Pigmented stones are black (hard) or brown (soft). it appears to involve decreased secretion ofbile acids. the latter forming secondary to chronic biliary infection. and proteins. gamma-glutamyl (GGT). (2) diminished secretion of bile acids.295 In obese individuals the mechanism appears to involve cholesterol synthesis. Pigment stones are composed primarily of calcium bilirubinate. and mucin. ERCP 5. The formation of brown stones is associated with bacterial infection of the bile ducts with formation of stone composed of calcium soaps. Patofisiologi Gallstones are formed because of abnormal bile composition. and (6) some combination of these mechanisms. Helical CT scans and MRI. They are more common in East Asia. they contain <20% cholesterol and are classified into “black” and “brown” types. such as sickle cell anemia and Gilbert syndrome (hereditary hyperbilirubinemia). which normally promote cholesterol solubility. They are divided into two major types: cholesterol stones account for more than 80% of the total. unconjugated bilirubin. (4) gallbladder smooth muscle hypomotility and stasis. cholangiogram. which decrease the bile acid pool. cholesterol. whereas in nonobese individuals. LDH gamma-glutamyl . Pemeriksaan Diagnostik 1.D. transpeptidase (GGTP). celiac axis arteriography 2.

to remove the cause by pharmacotherapy.6. or surgical intervention. if possible. endoscopic procedures. . Cholesterol levels F. Penatalaksanaan Medis Major objectives of medical therapy are to reduce the incidence of acute episodes of gallbladder pain and cholecystitis by supportive and dietary management and.